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PubMed1999

Characteristic features of trabecular bone in edentulous maxillae.

Following tooth loss, the maxillary alveolar ridge is affected by extensive resorption and its cancellous bone substance undergoes intense remodeling processes. This is particularly important for endosseous implant surgery as the primary stability and thus the prognosis of endosseous implants depends on the cancellous bone density and structure of the alveolar ridge. To analyze the structure of alveolar trabecular bone, 156 sections were obtained from 52 edentulous maxillae (29 female, 23 male; mean age: 72.5 years) from the lateral incisor, first premolar, and first molar regions. The structural histomorphometric analysis was performed on cancellous bone of the section surfaces using semiautomatic image analysis. The following parameters were measured: trabecular bone volume, trabecular number, trabecular thickness, trabecular plate separation and trabecular interconnection. All examined parameters showed an extreme range of variation. A difference of more than 45% between the highest (= 51.93%) and the lowest (= 6.73%) trabecular bone volumes was found. Furthermore, the measurements showed that trabecular bone volume, thickness and number were distinctly lower in the molar region than in the incisal and premolar regions. Significant sex-specific differences were found in all investigated regions, female maxillae showing a smaller amount and a lower connectivity of cancellous bone than male maxillae.

Adult↗
PubMed2003

A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures.

A longitudinal clinical trial involving 103 subjects was undertaken to assess the impact of oral implant therapy on the psychosocial well-being of subjects with complete denture wearing problems. There were four experimental groups: (1) an implant group, where subjects were edentulous/edentate in one jaw and requested and received implants to retain an oral prosthesis (IG); (2) subjects edentulous/edentate in one jaw requesting implants but who received conventional dentures (CDG1); (3) edentulous subjects requesting replacement of their dentures by conventional means (CDG2); (4) dentate subjects requiring routine treatment, who were included for comparison. Data were collected in each group pre- and post-treatment using validated oral specific [the Oral Health Impact Profile (OHIP)], and generic (the SF36) health status measures. Subjects in IG, CDG1 and CDG2 also completed a denture satisfaction scale. IG and CDG1 subjects reported that tooth loss and denture wearing problems had a much greater impact on their quality of life than subjects seeking conventional dentures. Dentate subjects had a much better oral health status compared with denture-wearing subjects. Following treatment, subjects who received implant-retained prostheses (IG) reported a significant improvement in satisfaction and health-related quality of life, as did subjects who requested and received conventional dentures (CDG2). Subjects who requested implants, but received conventional dentures (CDG1), reported little improvement in denture satisfaction and only modest improvement in their quality of life. None of the denture-wearing subjects reported health-related quality of life that was as good as that of dentate subjects. The findings have significant implications in the assessment of outcomes in future clinical trials.

Adult↗
PubMed2000

The periodontal abscess: a review.

BACKGROUND/AIMS: The periodontal abscess is a frequent periodontal condition in which periodontal tissues may be rapidly destroyed. Its importance is based on the possible need of urgent care, the affectation of tooth prognosis, and the possibility of infection spreading. There is scant information in the scientific literature regarding this condition and most of it has been published as case reports and text books, where conclusions are not evidence-based, but rather empirical observations made by recognised clinicians. The aim of this review was to critically analyse all available information on this subject in the dental and medical literature, including information on its prevalence, proposed etiologies and pathogenesis, diagnosis, microbiology and treatment alternatives. SUMMARY: The periodontal abscess is the 3rd most frequent dental emergency, and it is specially prevalent among untreated periodontal patients and periodontal patients during maintenance. Different etiologies have been proposed, and 2 main groups can be distinguished, depending on its relation with periodontal pockets. In the case of a periodontitis-related abscess, the condition may appear as an exacerbation of a non-treated periodontitis or during the course of periodontal therapy. In non-periodontitis related abscesses, impaction of foreign objects, and radicular abnormalities are the 2 main causes. The abscess microflora seems to be similar to that of adult periodontitis, and it is dominated by gram-negative anaerobic rods, including well-known periodontal pathogens. Complications and consequences include tooth loss and the spread of the infection to other body sites. Diagnosis and treatment is mainly based on empiricism, since evidence-based data are not available. The role of systemic antibiotics, in the treatment of periodontal abscesses, is especially controversial.

Adult↗
PubMed2002

Associations of serum concentrations of IgG, IgA, IgM and interleukin-1beta with early-onset periodontitis classification and race.

BACKGROUND: The significance of serum concentrations of various antibodies and cytokines in the pathogenesis of early-onset periodontitis (EOP) is not well understood. Recent reports suggest differences between young blacks and whites in certain humoral responses, regardless of periodontal status. This study was undertaken to compare the serum concentrations of IgG, IgA, IgM, and IL-1beta in EOP subjects with that of healthy controls, and to study the effect of race on these levels. MATERIAL AND METHODS: This case-control study included 228 individuals, 19-25 years old who were selected from a larger population examined in the National Survey of Oral Health of United States Children in 1986/1987. The subjects were classified by their EOP status and they included 166 subjects with EOP and 62 healthy controls. Blood samples were used to assess the serum concentrations of IgG, IgM, IgA, IgG subclass, and IL-1beta. RESULTS: The serum concentrations of IgG, IgG subclasses, IgA, and IgM in blacks were not significantly different in the generalized, localized and incidental EOP groups as compared to the healthy controls. The serum IL-1beta concentration was slightly and uniformly lower in the EOP groups than in the control group, although not statistically significant. Blacks had significantly higher serum concentrations of total IgG, and of IgG1, IgG2 and IgG3 than whites and Hispanics. Hispanics had significantly higher serum concentrations of IgM and IgG4 than whites and blacks. Hispanics also had a significantly higher serum concentration of IL-1beta than blacks. CONCLUSIONS: Total antibody response in blacks is not associated with EOP classification. Race has a significant effect on serum antibody concentrations irrespective of disease classification, with blacks having significantly higher serum concentrations of IgG1, IgG2 and IgG3 than whites and Hispanics.

Adult↗
PubMed2003

Dental caries in postwar Bosnia and Herzegovina.

OBJECTIVES: To present the prevalence of dental caries in postwar Bosnia and Herzegovina (BH). METHODS: A survey focused on dmft and DMFT indices was carried out in four cantons of the Federation of BH in 1997. The dental health of 6- and 12-year-olds was assessed in random samples (n = 238 and 318, respectively). DMFT index in adult population was assessed in clients coming to dental offices in the same area (35-44-year-olds; n = 401). All the subjects were clinically investigated. RESULTS: During the 1991-95 war, all four cantons were affected by the migration of population. The population per dentist ratio considerably increased in three cantons. In 6-year-olds, the average dmft (+/-SD) was 4.9 +/- 4.0, and 86% of the children were affected with dental caries. The average DMFT of 12-year-olds was 6.2 +/- 3.9. On the average, 94% of the 12-year-olds were affected with dental caries. Mean DMFT of adult clients was 15.1 +/- 7.0. Almost every adult (98%) was affected with dental caries. CONCLUSIONS: The dental status in postwar BH is rather poor and the mean DMFT in all investigated age groups may be considered high. The detrimental effect of 1991-95 war on social conditions and the health care system should be considered in explaining such poor dental health. Despite the limitations, the presented data may be used to assess the treatment needs, assure the visibility for dental issues in BH, and help the west European countries to plan dental services for refugees from BH.

Adult↗
PubMed2000

An analysis of 58 traumatically intruded and surgically extruded permanent teeth.

Fifty-eight traumatically intruded and mainly surgically extruded permanent teeth were followed up for 3 years and 4 months (mid-term results: 29 teeth) and 9 months (short-term results: 29 teeth) on average. Statistically, the mid-term results showed more cases of severe crown discoloration (54%) than the short-term results (9%), but no difference in pulpal and periodontal healing. Three teeth (5%) were lost. Factors which positively influenced pulpal healing were shallow intrusion depth, intact crown and immaturity of the root. Factors which positively influenced periodontal healing were shallow intrusion depth and minimal surgical manipulation. Alveolar bone healing was positively influenced only by shallow intrusion depth.

Adolescent↗
PubMed2000

A multidisciplinary treatment approach to a complicated maxillary dental trauma: a case report.

This case report describes the treatment of an 18-year-old male who lost two central maxillary incisors due to dental trauma. Because of a deep overbite and serious occlusal instability, the lost teeth 11 and 21 could not be replaced by a conventional fixed prosthesis. The vertical dimension of occlusion was increased using a Hawley-type appliance over a period of 1 year. When sufficient intermaxillary space was gained the alveolar ridge was augmented with a mandibular symphysis graft. Nine months later two one-stage non-submerged implants (ITI, Straumann, Waldenburg, Switzerland) were inserted. After further soft tissue adaptation to two temporary acrylic crowns, porcelain veneers were placed on the two implants and the lateral incisors.

Adolescent↗
PubMed2003

Augmentation of the narrow traumatized anterior alveolar ridge to facilitate dental implant placement.

Traumatic tooth loss leads to alveolar resorption especially in sagittal direction. This can be due to avulsion of bone substance during the accident itself or due to resorption of the alveolar crest that takes place afterwards. Shortage of bone can prevent proper positioning of dental implants unless the volume of bone is increased before implantation. In the maxillary anterior area, this is also an esthetic problem. Several treatment modalities have been presented to augment the bone. This report reviews the latest literature on bone grafting, bone substitutes, guided bone regeneration, osteocompression and distraction which are potentially useful in the anterior maxilla. A special emphasis is paid to the versatility of using a crestal split osteotomy, by means of chisels and osteotomes to widen the narrow ridge. Three examples are illustrated showing onlay grafting, preservation of alveolar width with alloplastic coral material and lateral widening of a narrow maxillary alveolar ridge, using the crestal splitting technique.

Adult↗
PubMed1999

Dental caries status of preschool children in Hong Kong.

OBJECTIVE: To describe the dental caries status of preschool children in Hong Kong and factors which affect their caries status. DESIGN: 658 preschool children aged 4 to 6 years from six randomly selected kindergartens in Hong Kong were surveyed in December 1997. A questionnaire to investigate possible explanatory variables for caries status was completed by their parents. Dental caries was diagnosed according to the criteria recommended by the World Health Organization (1997). RESULT: Caries experience as measured by the mean number of decayed, missing and filled primary teeth (dmft) of the 4-, 5-, and 6-year-old children were found to be 0.9, 1.8, and 3.3 respectively. Overall, 61% of the children had a zero dmft score. Children born in Mainland China had a higher mean dmft score (4.6) than those born in Hong Kong (1.4). Statistically significant correlations were found between the children's dental caries status and their oral health practices as well as their socio-economic background. Parents' education level, dental knowledge and attitudes were also associated with the children's dental caries experience. CONCLUSION: In general, the caries status of Hong Kong Chinese preschool children was similar to that of children in industrialised countries and was better than that of children in the nearby areas. However, special dental programmes should be made available to children from lower socio-economic classes and new immigrants from Mainland China because they are the high risk groups for caries in Hong Kong.

Attitude to Health↗
PubMed2001

Good occlusal practice in children's dentistry.

The difference between paediatric dentistry and most other branches of dentistry is that in the child the occlusion is changing. Consequently 'Good Occlusal Practice' in children is a matter of making the right clinical decisions for the future occlusion. The clinician needs to be able to predict the influence that different treatment options will have on the occlusion when the child's development is complete.

Anodontia↗
PubMed1989

The 'high risk' group in periodontitis.

The high risk concept of periodontitis incorporates the theory that multiple tooth loss from periodontal disease affects a relatively small proportion of the population. This paper reviews and extends the evidence for such a concept by describing the occurrence and distribution of advanced bone loss in a Glasgow population of 800 dental out-patients. In common with other published studies of attachment loss or periodontal bone destruction, advanced bone loss was highly prevalent, affecting 54.1% of 50- to 73-year-olds. However, in parallel with other investigations, a small but with age increasing minority of patients accounted for most of the bone destruction. For example, in the 50- to 73-year-old age group, 28% of patients accounted for 75% of the advanced bone loss seen in that group.

Adolescent↗
PubMed1990

Short root anomaly.

A case of generalised short root anomaly is described. All permanent teeth had abnormally short roots, associated with microdontia, hypodontia and a dens invaginatus. Members of the patient's family were similarly affected.

Adolescent↗
PubMed1996

Restoration of a worn dentition using a double-veneer technique.

Restoration of dentitions affected by tooth surface loss has been a problem to the dental profession for many years. This problem is likely to increase as the population ages and retains more teeth into old age. This article describes a method of restoring teeth with non-carious loss of tooth tissue whilst conserving the remaining tooth tissue.

Aged↗
PubMed2004

Orthodontics. Part 12: Combined orthodontic treatment.

Dentistry is becoming more sophisticated and capable of providing much higher treatment standards than ever before. Treatments previously considered impossible can now be achieved as a direct consequence of these advances. However, this increased complexity of treatment also means that the different branches of dentistry have, as a necessity, become more and more specialised. It is important that the specialities collaborate in a systematic focused way to ensure the optimal treatment outcome with the minimum burden of care for the patient.

Cuspid↗
PubMed2004

Destructive membranous periodontal disease (ligneous periodontitis): a case report and 3 years follow-up.

Destructive membranous periodontal disease is a rare, destructive and poorly defined entity, which is the part of a systemic disease due to plasminogen deficiency and fibrin deposition. The disease is characterised by gingival enlargement and periodontal tissue destruction that leads to rapid tooth loss despite treatment attempts. Biopsy is essential to rule out other periodontal disease in the differential diagnosis.

Adult↗
PubMed2005

Insufficient evidence to understand effect of routine scaling and polishing.

DATA SOURCES: Relevant studies were sourced using the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials, Medline and Embase. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. STUDY SELECTION: Trials were selected if they were randomised, included anyone with an erupted permanent dentition, and where subjects were judged to have received a routine scale and polish as defined in this review. Outcomes assessed included tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes. DATA EXTRACTION AND SYNTHESIS: Trial details were independently extracted, in duplicate, by two reviewers. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both the standardised mean differences and weighted mean differences were calculated, as appropriate, using random-effects models. RESULTS: Eight studies were included in this review and all studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, which involved people attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each timepoint during the 1-year trial. The other study, of adolescents in a developing country who had high existing levels of and calculus who had not received any dental treatment for at least 5 years, reported statistically significant improvements in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish procedures provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing carried out at more frequent intervals, that is, at 2 weeks versus 6 months; 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); and at 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry. CONCLUSIONS: The research evidence is not of sufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High-quality clinical trials are required to address the basic questions posed in this review. Scaling and/or polishing of the crown and root surfaces of the teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing.

Comment↗
PubMed2005

Smokers have less reductions in probing depth than non-smokers following nonsurgical periodontal therapy.

DATA SOURCES: Studies were located using Medline, Embase and the Cochrane Central Register of Controlled Clinical Trials, as well as searching bibliographies of identified references, review articles and consensus statements by hand. STUDY SELECTION: As the habit of smoking cannot be randomised, studies included were both controlled clinical trials and arms of randomised controlled trials investigating the effects of nonsurgical periodontal treatment, which reported results separately for smokers and nonsmokers. Other inclusion criteria were that studies should assess otherwise healthy people who had been diagnosed with chronic or adult periodontitis and that the patient was the unit of analysis (rather than a tooth- or site-based analysis). Studies were not excluded on the basis of quality, only on whether they fulfilled the inclusion criteria for entry. DATA EXTRACTION AND SYNTHESIS: General information about the paper, study characteristics, outcome measures, treatment characteristics and quality assessment was extracted independently, in duplicate. Where disagreement arose, this was resolved by discussion. Meta-analysis of data was performed and heterogeneity between studies was investigated using meta-analysis regression. RESULTS: Out of the 330 studies initially identified, 13 were considered eligible for inclusion. No studies reported data on tooth loss. For all sites, the reduction in probing depth (PD) was 0.13 mm greater in nonsmokers than in smokers (six studies) and there was no evidence to suggest that the studies were dissimilar in their estimates of this result (no evidence of heterogeneity; P>0.05). For sites with an initial PD of 5.00 mm (eight studies), a random-effects meta-analysis indicated a weighted mean difference in PD reduction of 0.43 mm favouring nonsmokers (95% confidence interval (CI), 0.24-0.63; P<0.001). Because of significant heterogeneity between studies, only a cautious observation can be made but, with one exception, all studies produced a summary estimate favouring nonsmokers. Meta-analysis of the two studies that compared the change in clinical attachment level between nonsmokers and ex-smokers, who had given up their habit, in sites with an initial PD of +/-5.00 mm, showed a difference in clinical attachment level gain of 1.34 mm favouring the nonsmokers (95% CI, 0.65-2.03; P<0.001; chi(2) test for heterogeneity, 7.47 with 1 degree of freedom; P=0.006). In both of these analyses, the degree of heterogeneity is a cause for concern. Bleeding was assessed after therapy in seven studies but meta-analysis was not performed because of great heterogeneity in the methods used to assess bleeding. No statistically significant differences in bleeding were found between smokers and nonsmokers either at baseline or after therapy in most of the studies. One study found significantly less bleeding in smokers than in nonsmokers at baseline and another found a reduced response in terms of bleeding in smokers than in nonsmokers. Two studies evaluating the change in bleeding in ex-smokers found no statistically significant difference after treatment. No data were reported for any of the included studies on patient-centred outcomes such as quality of life, ease of maintenance, changes in aesthetic appearance, or patient experience. CONCLUSIONS: Following nonsurgical periodontal therapy, people who smoke will experience less reduction in PD than nonsmokers. There is no evidence of a difference in gain in clinical attachment between smokers and nonsmokers or a reduction of bleeding on probing between smokers and nonsmokers. Differences in study design and lack of data precluded an adequate and complete pooling of data for a more comprehensive analysis. In short-term studies, it is unclear whether people who stop smoking will respond as favourably to nonsurgical therapy as those who have never been smokers. Progress in understanding the effects of smoking on periodontal therapy will require the evaluation of objective measures of smoking such as nicotine exposure and exhaled carbon monoxide in place of sole reliance on patient-reported information.

Comment↗